Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Feb 26, 2015; 3(1): 26-35
Published online Feb 26, 2015. doi: 10.13105/wjma.v3.i1.26
Effect of institutional volume on laparoscopic cholecystectomy outcomes: Systematic review and meta-analysis
Muireann Murray, Donagh A Healy, John Ferguson, Khalid Bashar, Seamus McHugh, Mary Clarke Moloney, Stewart R Walsh
Muireann Murray, Donagh A Healy, Khalid Bashar, Seamus McHugh, Department of Surgery, University Hospital Limerick, Limerick, Ireland
John Ferguson, Department of Nephrology, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
Mary Clarke Moloney, Health Research Institute, University of Limerick, Limerick, Ireland
Stewart R Walsh, Department of Surgery, University College Hospital, Galway, Ireland
Author contributions: Walsh SR, Clarke Moloney M and McHugh S designed the research; Murray M identified eligible studies; Murray M and Healy DA extracted data; Healy DA, Ferguson J and Bashar K performed analysis; all authors contributed to drafting the manuscript and revising it critically; all authors approved the final draft.
Conflict-of-interest: The authors state that they have no conflicts of interest to declare.
Data sharing: Dataset and statistical code are available from the cooresponding author at the email address mentioned above.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Muireann Murray, Department of Surgery, University Hospital Limerick, Castletroy, Limerick, Ireland. muireannm80@gmail.com
Telephone: +353-61-482761 Fax: +353-61-233778
Received: April 11, 2014
Peer-review started: April 12, 2014
First decision: May 1, 2014
Revised: December 18, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: February 26, 2015
Processing time: 283 Days and 9.9 Hours
Abstract

AIM: To determine whether institutional laparoscopy cholecystectomy (LC) volume affects rates of mortality, conversion to open surgery, bile leakage and bile duct injury (BDI).

METHODS: Eligible studies were prospective or retrospective cohort studies that provided data on outcomes from consecutive LC procedures in single institutions. Relevant outcomes were mortality, conversion to open surgery, bile leakage and BDI. We performed a Medline search and extracted data. A regression analysis using generalized estimating equations were used to determine the influence of annual institutional LC caseload on outcomes. A sensitivity analysis was performed including only those studies that were published after 1995.

RESULTS: Seventy-three cohorts (127404 LC procedures) were included. Average complication rates were 0.06% for mortality, 3.23% for conversion, 0.44% for bile leakage and 0.28% for bile duct injury. Annual institutional caseload did not influence rates of mortality (P = 0.142), bile leakage (P = 0.111) or bile duct injury (P = 0.198) although increasing caseload was associated with reduced incidence of conversion (P = 0.019). Results from the sensitivity analyses were similar.

CONCLUSION: Institutional volume is a determinant of LC complications. It is unclear whether volume is directly linked to complication rates or whether it is an index for protocolised care.

Keywords: Abdominal; Cholecystectomy; Quality control; Systematic review; Meta-analysis

Core tip: We performed a meta-analysis to determine whether institutional laparoscopy cholecystectomy (LC) volume affects rates of mortality, conversion to open surgery, bile leakage and bile duct injury. Annual institutional caseload did not influence rates of mortality (P = 0.142), bile leakage (P = 0.111) or bile duct injury (P = 0.198) although increasing caseload was associated with reduced incidence of conversion (P = 0.019). Our results suggest that institutional LC volume may be a determinant of LC complications. It is unclear whether institutional LC volume is directly linked to complication rates or whether its influence is a surrogate for improved quality of care.